Modeling the impact of patient treatment preference on health outcomes in relapsing-remitting multiple sclerosis

Figures & data

Figure 1. Conceptual overview of study design. Notes. Study was executed in 4 steps: (1) a discrete choice experiment was performed to translate patient preferences into patient-centered market shared, (2) a Markov model was used to calculate the effect of prescribing behaviour (shares) on long-term health, (3) the preference shares and current market shares were used in the model to identify the long-term health outcomes of patients under patient-centered and current prescribing practices, (4) the incremental benefit of patient-centered prescribing over current prescribing practices in the UK was estimated. Abbreviations. DMD, disease-modifying therapy; EDSS, Expanded Disability Status Scale; QALY, quality-adjusted life-year.

Table 1. Key inputs of the economic model.

Input parameter	Parameter value or range	Source
Reduction in disability compared to BSC	HR range = 0.305 to 0.819 (see Supplemental Table 1 for treatment-specific values)	^42^,^45
Reduction in annualized relapse rate compared to BSC	HR range = 0.322 to 0.806 (see Supplemental Table 1 for treatment-specific values)	^43–45
Utilities (measured as QALY loss per event)
Utility by EDSS state	Range = –0.195 to 0.906 (see Supplemental Table 2 for EDSS state-specific values)	^44^,^51
Caregiver disutility by EDSS state	Range = –0.002 to –0.173 (see Supplemental Table 2 for EDSS state-specific values)	^53
Disutility per relapse	–0.071	^52
Disutility due to adverse events	Range = –0.011 to –1.000 (see Supplemental Table 3 for event-specific values)	^54–56
Mortality rate	Range = 0% to 16% (see Supplemental Table 4 for age- and EDSS state-specific values)	^57^,^58
Treatment discontinuation	Range (0 to 2 years) = 2.3% to 17.3%	^41
	Range (2 to 50 years) = 2.7% to 17.3% (see Supplemental Table 5 for treatment-specific values)
Treatment waning effect	100% (0 to 2 years)	^54^,^73^,^74
	75% (2 to 5 years)
	50% (>5 years)

Abbreviations. BSC, best supportive care; EDSS, Expanded Disability Status Scale; HR, hazard ratio; QALY, quality-adjusted life-year.

Table 2. Preference share estimation results.

Therapy	Patient preference share (base case)	Patient preference share (oral therapies only scenario)	Current market share
Natalizumab	28.3%	–	12.6%
Cladribine tablets	15.0%	38.8%	1.3%
Alemtuzumab	14.7%	–	4.8%
Teriflunomide	10.9%	28.0%	4.7%
Glatiramer acetate	8.7%	–	14.5%
Fingolimod	8.0%	20.6%	13.7%
Dimethyl fumarate	4.9%	12.7%	28.5%
Interferon beta-1a (Avonex^®)	3.3%	–	6.7%
Interferon beta-1b	2.1%	–	1.6%
Interferon beta-1a 44mg (Rebif^®)	2.0%	–	6.3%
Peginterferon beta-1a	2.0%	–	4.8%
Ocrelizumab	–	–	0.6%

Notes. Data for the current market shares were obtained from the Specialist Share Data from Wilmington Healthcare³⁷, based on patients who received a specified treatment in January 2019. The market shares for daclizumab and others in the Specialist Share Data comprised only 0.105% and were evenly distributed among the therapies above. Market shares for Betaferon^® and Extavia^® (both interferon beta-1b) were combined; market shares for Copaxone^® (glatiramer acetate) and generic glatiramer acetate were combined.

Figure 2. Cumulative total relapses and discounted QALYs gained. Abbreviations. QALY, quality-adjusted life-year; RRMS, relapsing-remitting multiple sclerosis.

Figure 3. Average EDSS over time. Abbreviations. EDSS, Expanded Disability Status Scale; RRMS, relapsing-remitting multiple sclerosis.

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